The double whammy of HIV and NCDs

Delft Community Health Centre sees around
35 000 patients a month from Cape Town’s northern areas, and every morning the corridors
and waiting areas are clogged with people.

Infectious diseases – especially
tuberculosis and HIV – are the main focus of the centre, but the incidence of non-communicable
diseases (NCDs) is steadily rising, particularly hypertension and diabetes.

Seven pills per day

Delft’s head of clinical services, Dr
Sheron Forgus, says that around 10% of the centre’s HIV positive
patients are also being treated for NCDs.

One of these is Elizabeth Meyer, who was
first diagnosed with HIV in 2002. She has managed to keep the virus in check
for many years and only started ARV treatment a couple of months ago. That part
is easy for her. She finds her diabetes and hypertension far more difficult to
manage.

“Two years ago I was diagnosed with
diabetes. My mouth was dry, I had painful burning under my feet,” says the
soft-spoken 43-year-old mother.

Meyer now has to take seven pills every
day. In the morning, she takes a “big thick” diabetes pill, a blood pressure
pill and a cholesterol tablet. She repeats this at night, but adds her daily
ARV, which is a three-in-one pill.

“In the beginning, it was hard and I wanted
to vomit. I was drowsy and very nauseous but I am getting used to it,” says
Meyer. She is also trying hard to cut sugar, salt and fizzy drinks from her
diet and watch her weight, which is a constant battle.

Over 6 000 HIV positive patients have
started on ARVs at the centre, and around 2 200 are stable with undetectable
levels of the virus, says Sister Tresia Nontshinga, the operational manager for
infectious diseases.

A patient every 12 minutes

These stable patients are organised into
“clubs” of up to 25 people with similar disease profiles. Grouping the diabetic
HIV positive patients together, for example, both creates a support system and
makes it easier for nurses to address similar problems at the same time.

Forgus says that health workers working in
infectious diseases have become much more aware of NCDs in the past few years,
and are dedicated to screening their HIV positive patients. But it is
complicated and time-consuming.

Stable HIV positive patients get to see a
doctor once a year and these check-ups now take a long time as doctors need to
test for NCDs too – which means that they test their “eyes, feet, do blood
tests for their sugar levels, cholesterol tests, test their kidneys”, says
Forgus.

Each Delft doctor currently see 40 patients
a day – that’s a patient every 12 minutes if you work for eight hours flat out
without any breaks.

In addition, the different medicines bring
their own interactions. A class of ARVs called protease inhibitors (PI) can
cause diabetes, in part because the medicine interferes with the body’s
absorption of glucose.

Luckily, these are “second line” ARVs,
taken by people who have become resistant to normal treatment, and the health
department recently introduced a new ARV called dolutegravir, which doesn’t impact on
glucose.

Litres and litres of fizzy drinks

But dolutegravir interferes with a diabetes
medicine called metformin. The blood-thinning medicine, warfarin, for people in
danger of clots, interferes with TB medication.

There is also very little time to educate
patients about healthy habits, particularly related to diet.

“Our patients drink litres and litres and
litres of fizzy drinks,” says Forgus. “But the consultations are short and we
have to address everything in one visit. To encourage behaviour change, you
need at least 30 minutes with each patient.”

One of the centre’s busy doctors, Dr Marcia
Vermeulen adds: “Most of our patients are suffer from poor diet and inactivity.
But they are unemployed and looking for a job, not going to the gym. There are
no gyms here.”

By 2025, around 12,3-million South Africans
will be on long-term medication for HIV and various NCDs, according to the Department
of Health. This is going to put massive
strain on the health system.- Health-e News.